When President Donald Trump encouraged Ohio gubernatorial candidate Vivek Ramaswamy to keep running the despicable attack ad featuring his opponent Amy Acton’s estranged mother, the message to survivors of sexual abuse was unmistakable. The TV ad shows the Democratic candidate’s mother, who defended Acton’s stepfather after he was accused of sexually abusing Acton starting at 9 years old, and who lost custody of Acton and her brother after her stepfather was indicted for raping her.

Trump called the ad “hitting pay dirt.”Vice President JD Vance dismissed it as “not really my concern.”Ironically, keeping the American public safe from harm — regardless of their political affiliation — is arguably the most important duty of the president and vice presidential offices.

Ramaswamy’s campaign committed $4 million to promote the ad. On Thursday, Ohio’s Republican Gov. Mike DeWine said his wife had seen the spot on television that morning, indicating the campaign had moved from defending the ad to actually putting it into people’s homes for anyone to watch. Donald Trump Jr. also urged Ohio voters to watch it.

As a surgeon who has cared for survivors of sexual abuse, I am concerned about the people watching the ad who themselves have experienced sexual abuse, who will never appear on a ballot. What does it tell them when the president and vice president defend the public humiliation of someone who endured childhood sexual abuse, just to score political points? It tells them that the very people elected to protect them will abandon and defame them, just to win. These endorsements take a family’s rejection of a survivor’s testimony and back it with national political power.

For a survivor of sexual abuse, any reminder of abuse can bring the past painfully into the present, forcing them to relive what happened to them. Survivors of childhood sexual abuse especially go through multiple, sometimes lifelong cycles of self-blame and guilt after disclosure, especially given that the majority of children who are sexually abused know their abuser, as in Acton’s case.

A child may blame herself for the upheaval that follows disclosure: leaving home, losing contact with a parent, seeing a sibling’s life disrupted. She may wonder whether staying silent would have kept her family together. That is a devastating burden for a child, and the ensuing adult, to carry. As professionals who work with survivors, we must make clear that telling someone did not make her responsible for the abuse or its consequences. The responsibility belongs to the adults who harmed her and failed to protect her.

Broadcasting Acton’s mother’s words risks reinforcing precisely that misplaced guilt that we work so hard to heal. And when the president and vice president defend and support it, they give a survivor’s deepest self-doubt the authority of the highest offices in the country.

No responsible physician can diagnose Acton from a campaign , and survivors will respond differently. But for some viewers, hearing a mother denounce her daughter who reported abuse could evoke their own experiences or fears of disclosure, rejection or disbelief. Repeatedly airing the spot creates repeated opportunities for that encounter.

The response to disclosure matters. A 2019 systematic review and meta-analysis of 51 studies, published in Clinical Psychology Review, found that negative reactions to disclosures of interpersonal violence were associated with worse mental health. That research does not measure this ’s effects. But it does establish why dismissing survivors’ concerns as political oversensitivity, as Vance is doing, is medically irresponsible and morally reprehensible.

Then there is the person who has never told anyone. The Rape, Abuse & Incest National Network identifies fear of disbelief, retaliation and losing support among the barriers to reporting sexual violence. Imagine weighing those fears while watching a survivor’s estranged mother become a campaign asset, with the president’s encouragement. A frightened child could reasonably wonder: If this is what happens to a prominent doctor and political figure, what will happen to me?

That possibility should trouble every public official. The Centers for Disease Control and Prevention estimates that at least 1 in 4 girls and 1 in 20 boys in the U.S. experience childhood sexual abuse. The audience for this spectacle includes people carrying experiences their spouses, colleagues or children may know nothing about.

In medicine, our responsibility is to make it safer to ask for help. We should listen without judgment, respect patients’ choices and treat their distress seriously. Needing treatment is not a character defect. Neither is having a parent who failed to protect you. Nor should survivors have to earn compassion by becoming physicians. Acton’s accomplishments do not make her more deserving of dignity than someone whose trauma interrupted an education, damaged relationships or made holding a job difficult. Recovery is not an audition for public sympathy.

The endorsement matters because it offers permission. A campaign uses a survivor’s family history against her. Powerful allies defend the tactic. Objections become evidence of weakness or disloyalty. I worry about how that example lands with people already reluctant to seek help, and with the people they might turn to.

There is an obvious alternative. Ramaswamy can withdraw the ad. Trump and Vance can say that survivors’ childhood suffering should never become campaign ammunition. They can debate Acton’s public record without elevating the rejection she experienced as a child.

Their responsibility extends to the survivor watching alone at home, wondering whether speaking up will bring support or punishment. That person deserves a better answer than the one these leaders are giving.

Every survivor watching this ad deserves a clear message: What happened to you was not your fault. Your suffering is not a character flaw. Your future does not belong to the people who failed to protect you.

Ramaswamy is spending $4 million amplifying that betrayal, and Trump and Vance are defending his right to do it. Anyone willing to make a survivor’s humiliation the price of political victory has absolutely no business anywhere near the seat of power.